Quality Improvement Care Coordinator - Verity

Roles & Responsibilities

The Quality Improvement Operations Coordinator drives performance improvement maximizing member compliance for Verity’s Value-Based Shared Savings Program by offering administrative and operational support, focusing on quality and process improvement, medical record collection, provider updates, and performance reporting. 

Organization of value-based reporting and assessing overall quality, program effectiveness, and outcomes for Providers/Members to continually improve QI Operations.

Collects and summarizes performance data, identifies opportunities for improvement, and presents findings. Analyzes current workflows and standards against performance data to assess process adherence and makes recommendations for improvement. Manages coordinating and organizing medical record review projects by emailing non-compliant lists, collecting records, uploading for abstraction, and documenting appropriately. Assist with quarterly provider visit preparations. Develop/edit/maintain report job aids and deliver training and coaching on existing and newly developed reports. Format and upload attribution, ED, and gap-in-care reporting monthly. Manage all provider adds, changes, and terms. Data analysis of all MCO contract reporting for validation of measure outcomes. Maintain communication with provider groups to collect pieces of HEDIS measure specifications unidentified medical record.

·          Serves as a resource contact and information/education source to patients, families, providers, and/or staff.

Meet departmental goals and objectives by supporting Quality initiatives. Update monthly HEDIS tracker and quarterly attribution changes. Maintain knowledge of HEDIS specifications in accordance with NCQA guidelines. Follow all departmental Policies and Procedures for compliance. Helps with special projects, as assigned by Director. Always represent the organization well; support its mission, goals, and objectives; participate as a “team player,” set an example of high personal and professional conduct for employees and others. Two years of experience gathering, editing, and analyzing data; or an equivalent combination of education and experience. Two years of experience in the field of quality management/continuous quality improvement preferred. Healthcare-related experience is preferred. Demonstrated relationship-building and influential skills. Prefer to have a base knowledge of HEDIS and NCQA. Outstanding Customer Service and follow-up skills. Strong organizational and time management skills, able to work with minimal supervision. Excellent written/verbal communication skills, especially the ability to communicate telephonically in a professional and effective manner. Computer literacy in Microsoft Office Suite (Excel, Word, Outlook, PowerPoint) and Internet navigation. Skilled in Excel with very strong skills including but not limited to filtering, formulas, creation of charts and graphs, and pivot tables. Establish and use quality metrics to drive change and deliver measured improvements. Knowledge and understanding of managed care organizations and value-based contract requirements. Ability to multi-task in a fast-paced environment.

Education Requirements

Bachelor’s degree or equivalent combination of education and experience

Full-Time